Provider Demographics
NPI:1871804724
Name:SIMONE, MARK SAMUEL (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:SAMUEL
Last Name:SIMONE
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Gender:M
Credentials:PHYSICAL THERAPIST
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Mailing Address - Street 1:14622 VENTURA BLVD
Mailing Address - Street 2:SUITE 102/UNIT 550
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3600
Mailing Address - Country:US
Mailing Address - Phone:818-480-8397
Mailing Address - Fax:818-788-7254
Practice Address - Street 1:14622 VENTURA BLVD
Practice Address - Street 2:SUITE 102/UNIT 550
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3600
Practice Address - Country:US
Practice Address - Phone:818-480-8397
Practice Address - Fax:818-788-7254
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
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Provider Licenses
StateLicense IDTaxonomies
CAPT15218225100000X, 2251G0304X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic